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Acute perioperative pain

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https://www.readbyqxmd.com/read/29137580/prevalence-and-predictors-of-persistent-post-surgical-opioid-use-a-prospective-observational-cohort-study
#1
N Stark, S Kerr, J Stevens
Post-surgical opioid prescribing intended for the short-term management of acute pain may lead to long-term opioid use. This study was undertaken to determine the prevalence of persistent post-surgical opioid use and patient-related factors associated with post-surgical opioid use. One thousand and thirteen opioid-naïve patients awaiting elective surgery in a tertiary private hospital in Sydney were enrolled. Preoperatively, patients completed a questionnaire comprising potential predictors of persistent post-surgical opioid use...
November 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29121294/low-dose-buprenorphine-infusion-to-prevent-postoperative-hyperalgesia-in-patients-undergoing-major-lung-surgery-and-remifentanil-infusion-a-double-blind-randomized-active-controlled-trial
#2
Marco Mercieri, Stefano Palmisani, Roberto A De Blasi, Antonio D'Andrilli, Alessia Naccarato, Barbara Silvestri, Sara Tigano, Domenico Massullo, Monica Rocco, Roberto Arcioni
Background: Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29121288/benefit-and-harm-of-pregabalin-in-acute-pain-treatment-a-systematic-review-with-meta-analyses-and-trial-sequential-analyses
#3
M L Fabritius, C Strøm, S Koyuncu, P Jæger, P L Petersen, A Geisler, J Wetterslev, J B Dahl, O Mathiesen
Pregabalin has demonstrated anti-hyperalgesic properties and was introduced into acute pain treatment in 2001. Our aim was to evaluate the beneficial and harmful effects of pregabalin in postoperative pain management. We included randomized clinical trials investigating perioperative pregabalin treatment in adult surgical patients. The review followed Cochrane methodology, including Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and used trial sequential analyses (TSAs). The primary outcomes were 24 h morphine i...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29120931/perioperative-neurocognition-in-elderly-patients
#4
Huiqun Fu, Long Fan, Tianlong Wang
PURPOSE OF REVIEW: The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. RECENT FINDINGS: Impairment of cerebral autoregulation may predispose patients to intraoperative cerebral malperfusion, which may subsequently induce postoperative cognitive disturbance...
November 7, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29067198/an-extended-release-local-anaesthetic-potential-for-future-use-in-veterinary-surgical-patients
#5
REVIEW
B Duncan X Lascelles, Kristin Kirkby Shaw
One of the most effective means of preventing the transduction and transmission of acute and perioperative pain is through the use of local anaesthetics. However, local anaesthetics currently available have a relatively short duration of action. Although there are several tools available to treat perioperative pain in companion animals, overall, there is an unmet need for products that can be administered in the clinic, and provide pain relief for the crucial first few days following surgery in the home environment...
November 2016: Veterinary Medicine and Science
https://www.readbyqxmd.com/read/29049123/impact-of-enhanced-recovery-after-surgery-and-opioid-free-anesthesia-on-opioid-prescriptions-at-discharge-from-the-hospital-a-historical-prospective-study
#6
Delara Brandal, Michelle S Keller, Carol Lee, Tristan Grogan, Yohei Fujimoto, Yann Gricourt, Takashige Yamada, Siamak Rahman, Ira Hofer, Kevork Kazanjian, Jonathan Sack, Aman Mahajan, Anne Lin, Maxime Cannesson
BACKGROUND: The United States is in the midst of an opioid epidemic, and opioid use disorder often begins with a prescription for acute pain. The perioperative period represents an important opportunity to prevent chronic opioid use, and recently there has been a paradigm shift toward implementation of enhanced recovery after surgery (ERAS) protocols that promote opioid-free and multimodal analgesia. The objective of this study was to assess the impact of an ERAS intervention for colorectal surgery on discharge opioid prescribing practices...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049119/a-review-of-opioid-sparing-modalities-in-perioperative-pain-management-methods-to-decrease-opioid-use-postoperatively
#7
REVIEW
Kanupriya Kumar, Meghan A Kirksey, Silvia Duong, Christopher L Wu
There is an epidemic of opioid use, abuse, and misuse in the United States, which results in significant morbidity and mortality. It may be difficult to reduce perioperative opioid use given known acute surgical trauma and resultant pain; however, the discrete and often limited nature of postoperative pain also may make management easier in part by utilizing nonopioid modalities, such as regional anesthesia/analgesia, and multimodal analgesia, which may decrease the need for powerful opioids. This article reviews the relevant literature describing the use of adjunct medications, regional anesthesia and analgesic techniques, and regional block additives in the context of providing adequate pain control while lessening opioid use...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049117/chronic-opioid-use-after-surgery-implications-for-perioperative-management-in-the-face-of-the-opioid-epidemic
#8
REVIEW
Jennifer M Hah, Brian T Bateman, John Ratliff, Catherine Curtin, Eric Sun
Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049115/an-evidence-based-approach-to-the-prescription-opioid-epidemic-in-orthopedic-surgery
#9
REVIEW
Ellen M Soffin, Seth A Waldman, Roberta J Stack, Gregory A Liguori
Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29033356/intraoperative-analgesia-guided-by-the-analgesia-nociception-index-in-bariatric-surgery-an-unmatched-case-control-study
#10
Lisa Le Gall, Anaëlle David, Pauline Carles, Sébastien Leuillet, Brigitte Chastel, Catherine Fleureau, Antoine Dewitte, Alexandre Ouattara
INTRODUCTION: Analgesia Nociception Index (ANI) has been proposed for the evaluation of the nociception-antinociception balance in the perioperative period. In obese patient, where the management of analgesia may be rendered difficult by pharmacological changes, we hypothesized that the monitoring of analgesia with ANI would reduce intraoperative opioid consumption during bariatric surgery. METHODS: This monocentric, observational, unmatched case-control study aimed to compare perioperative data from obese subjects (body mass index ≥ 35kg...
October 12, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29030938/opioid-use-disorder-and-misuse-a-review-of-the-epidemiology-and-medical-implications-for-pediatric-anesthesiologists
#11
REVIEW
Emily Knipper, Caleb J Banta-Green, Nathalia Jimenez
This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29027773/perioperative-pain-management-in-cardiac-surgery-a-systematic-review
#12
Elena Bignami, Alberto Castella, Vincenzo Pota, Francesco Saglietti, Antonio Scognamiglio, Cinzia Trumello, Maria C Pace, Massimo Allegri
BACKGROUND: Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often underestimated problem. METHODS: Following PRISMA Guidelines, a systematic literature search was carried out by two independent researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the keywords: [(perioperative OR postoperative) analgesia AND "cardiac surgery"]...
October 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29026331/poorly-controlled-postoperative-pain-prevalence-consequences-and-prevention
#13
REVIEW
Tong J Gan
This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29025135/current-perspective-on-the-use-of-opioids-in-perioperative-medicine-an-evidence-based-literature-review-national-survey-of-70-000-physicians-and-multidisciplinary-clinical-appraisal
#14
Jonathan S Jahr, Sergio D Bergese, Ketan R Sheth, Nicholas M Bernthal, Hung S Ho, Nicoleta Stoicea, Christian C Apfel
Objective: Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. Methods: The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk...
August 16, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29025089/oral-ketamine-for-acute-pain-management-after-amputation-surgery
#15
Asokumar Buvanendran, Jeffrey S Kroin, Arvind Rajagopal, Sherry J Robison, Mario Moric, Kenneth J Tuman
Objective: Intravenous ketamine has been shown to provide postoperative analgesia in many clinical trials, in particular to reduce opioid consumption. The primary objective of this pilot study is to determine if multiple dosing over a three-day perioperative period with oral ketamine is a safe treatment method for acute pain after amputation surgery. Methods: Three consented subjects (age 57-60 years) undergoing elective amputation of the lower extremity were included in the study (Institutional Review Board and Food and Drug Administration Investigational New Drug approved)...
September 14, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29020709/absorbaseal%C3%A2-vascular-closure-device-a-novel-device-for-hemostasis-following-interventional-peripheral-vascular-procedures
#16
Emily Benham, Koen Deloose, Joren Callaert, Marc Bosiers, Tiffany Cox, Amy Lincourt, B Todd Heniford
INTRODUCTION: Vascular closure devices (VCDs) are designed to achieve rapid hemostasis during percutaneous coronary and peripheral vascular procedures. Studies demonstrate that VCDs improve time to hemostasis (TTH) and time to ambulation (TTA) in comparison to standard manual compression. The available products, however, typically have 13-17 steps in their application, often require hemostatic collagen or other agents as part of the process, and can result in significant scarring at the puncture site that can impact future access...
October 12, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29019885/two-incision-laparoscopic-appendectomy-for-a-severe-hemophilia-a-child-patient-with-coagulation-factor-vii-deficiency-case-report-and-review-of-literature
#17
Jin Peng He, Jie Xiong Feng
RATIONALE: The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28993112/hospitalization-due-to-acute-exacerbation-of-chronic-pain-an-intervention-study-in-a-university-hospital
#18
Daniel W Wheeler, Sara Kinna, Andrew Bell, Peter J Featherstone, David J Sapsford, Sam P Bass
BACKGROUND AND AIMS: Hospitalization as a result of acute exacerbation of complex chronic pain is a largely hidden problem, as patients are often admitted to hospital under a variety of specialities, and there is frequently no overarching inpatient chronic pain service dedicated to their management. Our institution had established an inpatient acute pain service overseen by pain physicians and staffed by specialist nurses that was intended to focus on the management of perioperative pain...
October 6, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28938298/safety-and-efficacy-of-epidural-analgesia
#19
Elke M E Bos, Markus W Hollmann, Philipp Lirk
PURPOSE OF REVIEW: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. RECENT FINDINGS: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia...
December 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28936554/preoperative-flurbiprofen-axetil-administration-for-acute-postoperative-pain-a-meta-analysis-of-randomized-controlled-trials
#20
Ke Wang, Jun Luo, Limin Zheng, Tao Luo
OBJECTIVE: Non-steroidal anti-inflammatory drugs have been shown to effectively decrease postoperative pain and reduce opioid requirements. Flurbiprofen axetil is an injectable non-selective cyclooxygenase inhibitor that has a high affinity for inflammatory tissues to achieve targeted drug therapy and prolonged duration of action. This meta-analysis examined the use of preoperative flurbiprofen axetil and its impact on postoperative analgesia. METHODS: An electronic literature search of the Library of PubMed, Cochrane CENTRAL, and EMBASE databases was conducted in Feb 2016...
December 2017: Journal of Anesthesia
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